Keywords: Cannabis, Medical education, Policy, Medical students, Survey
1. Introduction
Over-the-counter and prescribed medical cannabis products are used by patients for various conditions including psychiatric disorders, pain management, and other neurodegenerative conditions.1 Despite this growing public interest and increasing legal availability, formal teaching on cannabis during medical school and residency in the United States is limited. A study by Evanoff et al2 found that 25 % of surveyed medical school curriculum deans reported that their graduates were not at all prepared to answer questions about medical cannabis. They also found that 84.9 % of surveyed residents and fellows reported receiving no education on cannabis in medical school or residency, and only 9 % of curricula in the AAMC Curriculum Inventory mentioned any medical cannabis education in 2015–2016.2
Along these lines, very little has been studied about the medical cannabis educational needs of trainees and practicing physicians in the US. In contrast, a 2015 study by the McGill University Health Research Institute details the results of an online needs assessment of over 400 Canadian physicians. They identified the most desired area for increased learning to be cannabis safety and the greatest gap between current perceived knowledge and desired knowledge to be dosing and the development of treatment plans.3 A later study of 182 Canadian nurse practitioners found similar results.4 In addition, 76.3 % of this sample of nurse practitioners rated the need for cannabis education to be either “strong” or “very strong”.4
To our knowledge, only one prior publication has gathered survey data directly from American medical students: a 2017 study conducted by Chan et al at the University of Colorado reported that while 97 % of their participants supported future research and believed that cannabis can play a role in medical treatment, less than half (45 %) would recommend it to a patient even if legally available.5 Following those studies, we investigated the extent to which medical students at The George Washington University (GWU) wish to learn about medical cannabis and assessed their subjective preparedness to counsel patients in this regard.
2. Methods
An online survey (Table 1) was administered to medical students at GWU. To assure that only medical students could complete this survey, volunteer participants were recruited via student-only class email lists, containing a total of 845 accounts, and class social media pages order to reach all currently enrolled students. Responses were collected anonymously without personal or demographic data using Google Forms. The Institutional Review Board at The George Washington University approved this study.
Table 1. Questions and responses to the GW medical student cannabis survey.
| Medical School Class | Percentage of Sample | How much formal education have you received on medical cannabis in medical school? | |||
|---|---|---|---|---|---|
| None at all | A little bit | A sufficient amount | Frequently covered | ||
| 1st Year | 37.1% | 29% | 9% | 0% | 0% |
| 2nd Year | 20% | 8% | 11% | 1% | 0% |
| 3rd Year | 21.9% | 13% | 8% | 1% | 0% |
| 4th Year | 21% | 10% | 10% | 0% | 0% |
| Total | 100% | 60.0% | 38.1% | 1.9% | 0.0% |
| Medical School Class | Percentage of Sample | I believe there should be more formal education on medical cannabis in medical school classes. | ||||
|---|---|---|---|---|---|---|
| Strongly Disagree | Disagree | Neutral | Agree | Strongly agree | ||
| 1st Year | 37.1% | 1% | 2% | 7% | 16% | 11% |
| 2nd Year | 20% | 0% | 0% | 3% | 10% | 8% |
| 3rd Year | 21.9% | 0% | 1% | 3% | 12% | 6% |
| 4th Year | 21% | 0% | 2% | 5% | 9% | 6% |
| Total | 100% | 1.0% | 4.8% | 17.1% | 46.7% | 30.5% |
| Medical School Class | Percentage of Sample | I have encountered a patient in clinic who was curious about medical cannabis. | |
|---|---|---|---|
| Yes | No | ||
| 1st Year | 37.1% | 13% | 24% |
| 2nd Year | 20% | 9% | 11% |
| 3rd Year | 21.9% | 17% | 5% |
| 4th Year | 21% | 16% | 5% |
| Total | 100% | 55.2% | 44.8% |
| Medical School Class | Percentage of Sample | How prepared do you feel to counsel a patient on the health HAZARDS of cannabis use? | |||
|---|---|---|---|---|---|
| Not at all prepared | Slightly prepared | Prepared | Very Prepared | ||
| 1st Year | 37.1% | 28% | 6% | 4% | 0% |
| 2nd Year | 20% | 10% | 8% | 3% | 0% |
| 3rd Year | 21.9% | 9% | 7% | 5% | 2% |
| 4th Year | 21% | 9% | 12% | 0% | 0% |
| Total | 100% | 54.3% | 32.4% | 11.4% | 1.9% |
| Medical School Class | Percentage of Sample | How prepared do you feel to counsel a patient on the health BENEFITS of cannabis use? | |||
|---|---|---|---|---|---|
| Not at all prepared | Slightly prepared | Prepared | Very prepared | ||
| 1st Year | 37.1% | 24% | 13% | 0% | 0% |
| 2nd Year | 20% | 14% | 6% | 0% | 0% |
| 3rd Year | 21.9% | 10% | 9% | 3% | 1% |
| 4th Year | 21% | 10% | 11% | 0% | 0% |
| Total | 100% | 57.1% | 39.0% | 2.9% | 1.0% |
3. Results
One-hundred and five students completed the survey (RR = 12.42 %, 95 % CI, +/− 8.96 %). As shown in Table 1, participants were spread across all four years of medical school: 37.1 % were first-year students, 20 % were second-year students, 21.9 % were third-year students, and 21 % were fourth-year students. Sixty percent of all participants (50 % of fourth-years, 61 % of third-years, 38.1 % of second-years, and 76.1 % of first-years) claimed that they have received no cannabis education in medical school; only two participants (1.9 %) endorsed “a sufficient amount” and zero responded that the topic was “frequently covered.” When given the statement “I believe there should be more formal education on medical cannabis in medical school classes”, 30.5 % of all participants strongly agreed, 46.7 % agreed, five (4.8 %) disagreed, and one strongly disagreed. The majority (55.2 %) of all participants (77.3 % of fourth-years, 78.3 % of third-years, 42.9 % of second-years, and 35.9 % of first years) had encountered a patient who was curious about medical cannabis. Most students felt “not at all prepared” to counsel patients on the health benefits (57.1 %) or risks (54.3 %) of cannabis use. Only four students (3.9 %) felt “prepared” or “very prepared” to discuss the benefits, and 14 (13.3 %) felt “prepared” or “very prepared” to discuss the risks.
4. Conclusion
The perceived knowledge gap demonstrated by this survey indicates that US medical students could very well benefit from increased undergraduate medical cannabis education. These participants overwhelmingly reported that they are not comfortable with their level of cannabis knowledge and would like to learn more while in medical school. Furthermore, the lopsided nature of these results is striking because these participants study medicine in Washington, D.C., where medical use became legal in 2010, recreational and private use became legal in 2015, and 6015 medical cannabis patients are registered users as of May 2019.6 By comparison, medical students studying in areas of the country where access remains restricted may feel even less confident, although further research is needed to confirm this.
One of the key limitations to our study was a relatively low response rate (12.42 % of 845). This could have introduced a source of bias in which students with stronger opinions about medical cannabis may have been more likely to participate in this study, thus skewing results. In addition, this survey was completed by participants who compose one four-year snapshot of medical students, and it is possible that other medical school classes will have different opinions that are not represented in this report.
Altogether, deficits in cannabis knowledge will need to be addressed as medical and recreational legalization continues to expand throughout the US. A lack of understanding of medical cannabis may negatively impact proper care of patients and harm the physician-patient relationship. We urge medical schools and medical education regulatory bodies to strongly consider adopting standards for cannabis education to ensure that future physicians can provide the best possible care to their patients.
Funding information
The authors received no financial support for the research, authorship, or publication of this article.
Declaration of Competing Interest
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the review.
Acknowledgements
The authors express gratitude to Dean Lawrence “Bopper” Deyton and the Cannabis as a Medicine Interest Group (CANMIG) at GWU in their support of this project.
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